One of the most common reasons for a patient to desire revision breast surgery is to change the size of their implants. Some patients feel their breasts are too large after an initial breast augmentation surgery whereas others may feel that their breasts did not gain enough volume after surgery. In these types of situations, the implants may be switched out for smaller or larger implants respectively. If the breasts are made too large, some women complain that they feel “top heavy” and they often have difficulty shopping for and wearing standard size clothing. Having said that, ninety percent of women that undergo revision breast surgery still desire to increase the size of their breast implants. The remaining ten percent of women either desire to stay the same size or have smaller breast implants during revision surgery. If a woman desires to go with smaller breast implants and skin laxity results, some sort of breast lifting techniques may be necessary to remove the extra skin. If a woman desires to have her implants removed all together, a breast lift procedure may or may not be necessary depending on the amount of breast tissue and skin remaining after the removal of the implants.
Another reason that women may want to perform an implant exchange is to switch their current type of breast implant. There are two types of breast implants currently available for use in breast augmentation surgery in the United States: saline-filled and silicone gel-filled breast implants. Each implant type has its own unique advantages and disadvantages in any given individual situation and there are several reasons that a patient may desire to switch their saline breast implants for silicone breast implants. Because saline breast implants are adjustable after their implantation inside of the breast, they can allow for correction of breast volume asymmetries while the size of the pre-filled silicone implants is non-adjustable. Secondly, saline implants are more of a “shaping” implant than silicone gel-filled implants because they can have a greater “rounding” and lifting effect on the breast mound than the softer silicone implants. For this reason, patients that feel their breasts look “too natural” or feel “too soft” after implantation with silicone breast implants often desire changing to saline breast implant in order to have “perkier”, “rounder” looking breasts. For this same reason, saline breast implants are often also more useful than silicone breast implants in combination with minor breast lifting techniques. The main reason some patients seek to switch their saline breast implants to silicone breast implants is to create more “natural” appearing breasts that may feel softer than breasts containing saline breast implants. Silicone implants do a wonderful job of giving a woman a larger version of whatever shape breasts she has prior to surgery and they are extremely effective in creating very natural and soft appearing breasts in women that already have perky, small, evenly shaped breasts. Solid/highly cohesive silicone gel-filled breast Implants (i.e Gummy Bear Implants) are unfortunately much firmer than all other currently available silicone gel breast implants. Therefore, many women desire to have their “firm” gummy bear implants exchanged for the softer FDA approved silicone gel implants. In addition, because gummy bear implants are anatomically shaped, they can lead to loss of upper pole breast fullness and they can also rotate inside of the breast pocket which can cause asymmetries and distortions of the breasts that require replacement and revision surgery to correct. Lastly, women who are interested in removing their implants all together may be able to reconstruct the remaining breast mound with fat grafting. Fat grafting can also be used to make cosmetic improvements during or after breast augmentation placement, revision or removal.
There are two main types of possible implant shells: smooth and textured (rough). Textured implants have a thicker, more palpable shell, leading to a higher risk of rippling and palpability of the implant. Also, textured breast implants have a higher risk of implant malposition and asymmetry since they “stick” to the surrounding breast tissue and therefore must be placed exactly in the desired position during surgery. This “stickiness” also makes breast massage protocols more difficult which may increase the risk of post-operative internal scar formation (capsular contracture). Therefore, if someone has textured breast implants and is experiencing rippling and/or palpability of the breast implants, switching to a smooth implant shell may greatly improve the feel and appearance of the breasts. Secondly, if someone has developed a capsular contracture with textured breast implants, switching to smooth shell implants may decrease the risk of capsular contracture recurrence after corrective surgery.
Breast implants come in a variety of shapes and contours (profiles). The “profile” of implant refers to its relative “height” compared to its volume (i.e. the “higher” the profile of an implant, the “taller” the implant is for a given volume). I do not typically recommend a contour/anatomic/teardrop shaped implant for use in breast augmentation because they can rotate after insertion, they do not offer much upper pole fullness of the breast and they typically come with a texted shell that does not allow for repositioning without additional surgery. Switching between the different profile implants can be done in order to produce a particularly more desirable look after corrective surgery. Switching to lower profile implants may give the breasts a “softer” more “natural appearance where as switching to a higher profile implant may give the breast a “perkier” more “round” appearance.
- Implant Exchange
- Capsular Contracture
- Breast Implant Rupture
- Correction of Implant Malposition and Breast Pocket Reconstruction (Symmastia/Bottoming Out/Dropped Fold/Double Bubble Deformity/Wide Cleavage/Lateral breasts):
- Enlarged Areolas
- Correction of Implant Rippling/Palpability
- Pre-Operative Period
- Day Of Surgery
- Post Operative 1 day | 1 week | 1 Month | Long Term